Shedding Pounds, Premium Dollars

William Ashmore, CEO of the State Employees’ Insurance Board in Alabama, felt frustrated. Government employees kept putting on more pounds and pushing up the state’s health care bills, even though the state had long encouraged them to receive wellness screenings, including weight and blood pressure checks. “It became very clear to us that obesity was one of the major drivers of health care costs,” Ashmore says.

By 2009, nearly 48 percent of state employees met the federal definition for obesity, with a body mass index of at least 30, compared with only about one-third of adults nationally. And their costs were rising proportionally. The state insurance board found that an employee with a body mass index of 30 to 34 averaged $490 more annually in medical costs compared with a healthy-weight colleague. For those who were even heavier, with a body mass index of 35 or higher, additional health care costs ranged from $907 to $1,719 annually.

So last year the insurance board decided to try the carrot approach to encourage employees to undergo wellness screenings and obtain medical help. Now all employees who are screened receive a $25 monthly discount on their 2010 health insurance premiums. That includes those employees who are classified as high risk because of their weight, blood pressure or other factors. But to receive that discount, they must also show that they’ve consulted with a physician about their health or taken another proactive step, such as enrolling in a weight-loss program.

Employees are classified as high risk, for example, if their body mass index is 35 or higher—at least 230 pounds for a 5-foot-8-inch individual. They also are asked to seek medical help if their blood pressure is at least 160/100, compared with the recommended target of 120/80 or lower.

Before implementing the premium discount, only about 30 percent of people got screened—typically the healthier employees, Ashmore says. In 2009, 95 percent of the state’s nearly 38,000 employees were screened. The point is to get at-risk employees into the medical system, he says. “We don’t want to get in the middle of dictating to individuals, ‘You have to do this and you have to do that.’ The treatment plan and the compliance with the treatment plan is between them and the physician.”

She joined a weight-loss program and started exercise classes. From early 2009 to mid-2010, she reduced her body mass index from 52 to 44. Her goal: to drop below a 35 body mass index. She already feels “a thousand times better,” she says, with more energy and a better attitude.